Take care when buying used Prisma machines Recently we have been advised of Prisma units being sold by third parties. While on the face of it these can seem a good buy, they may be missing the vital upgrades that are essential for optimum performance. The machines in question have typically been used in NHS Trusts and are now available for sale through a leasing company. These machines are unlikely to have had the latest software upgrade that we recently carried out on machines supplied directly by us. Our message is clear: any Prisma machine that has not had the software upgrade is not fit for purpose. If you have purchased one of these machines, or if you are thinking of doing so, please contact our Technical Services department. They can advise you accordingly, including in terms of the cost of the suitable upgrade. Gambro does offer pre-owned, fully upgraded Prisma machines with 12-month warranties. Alternatively you may wish to consider our Prismaflex machine, the latest generation of CRRT equipment. Contact Technical Service department 01480 444000, option number 3 Gambro’s citrate capability through Prismaflex The flexibility of the five pump design of the Prismaflex means that citrate can easily and safely be used to deliver anticoagulation during CRRT. High volume haemofiltration during citrate delivery is possible, as well as CVVHDF if required for improved small molecule clearances. The Prismaflex is capable of citrate delivery as standard, so there’s no need for expensive upgrades to the machine. All Prismaflex filter sets are also capable of delivering citrate, which eliminates the need to stock dedicated citrate sets. Using the Prismocitrate 10/2 on the predilution scale the Prismaflex infuses the citrate in to the circuit as the blood is removed from the patient. Additional replacement and dialysate may be used to achieve the required exchange rates/clearances. A calcium infusion may also be required dependent on the patient blood calcium levels. Gambro are able to provide guidelines on all relevant flow rates and monitoring to deliver citrate anticoagulation successfully. Contact Lloyd Buck 01480 444049 lloyd.buck@gambro.com 1 Monchi M, et al Citrate vs. heparin for anticoagulation in continuous venovenous heamofiltration; a prospective randomized study. Intensive Care Med 2004; 30: 260-5. 2 Kutsogiannis DJ, et al Regional citrate versus systemic heparin anticoagulation for continuous renal replacement in critically ill patients. Kidney Int 2005; 67:2361-7. 3. Meier-Kriescher HU, et al. Unexpected sever hypocalcaemia during continuous venovenous haemodialysis with regional anticoagulation. Am J Kidney Dis 1999;33:1-4. 4. Morgera S. et al. Metabolic complications during regional citrate anticoagulation in continuous venovenous haemodialysis: single centre experience. Nephron Clin Pract 2004;97:c131-c136. Isotonic fluids reduce the risk of side effects such as metabolic alkalosis and hypernatremia Call Customer Service for free! You can now contact Gambro’s Customer Service team for free by phone or fax, for everything from accessing product information to placing orders. Elaine Thompson, Sales Administration & Service Manager, says: “Last year we centralised our Europe-wide Customer Service team to Brussels, which has helped to make extensive product knowledge and experience available to UK customers. Now the addition of the free phone and fax numbers makes the service even better for UK customers.” This free service applies to all UK mainland customers, including Northern Ireland. Customers in the Republic of Ireland need to check with their network provider as we are unable to guarantee that their calls will be free. For all other services, you can still contact our UK Head Office at Huntingdon on 01480 444000. The new numbers are as follows: Telephone 0800 652 1380 Fax 0800 652 1390 Contact Elaine Thompson 01480 444034 elaine.thompson@gambro.com

Patients have a Home Care team to rely on When dialysis patients are undergoing self-care, it’s important that they have access to the support they need. Gambro’s Home Care team is proud to be helping hospitals to ensure this support is available. The team’s relationship with patients usually starts by helping them make the transition to home treatment. This begins with coordinating the installation of equipment and the delivery of their first month’s worth of treatment supplies, with extra stocks for emergency use. Once the self-therapy has begun, the team calls patients each month to take orders for consumables. Patients know when deliveries will be made so they can plan to be at home, or ask that alternative arrangements are made if a scheduled delivery date is not convenient. Building relationships with patients and clinicians “This is an area of our service we take very seriously,” says Home Care Coordinator, Lynne Kemp. “It’s vital that patients always have the supplies they need and so we liaise closely with them. But we do much more than taking orders for consumables. We don’t see ourselves as a faceless call centre, but instead have the time to listen to patients whenever they need someone to talk to. Showing them empathy and giving them comfort is something we feel is important, especially given the difficult circumstances they are often in when they call.” A high ultrafiltration rate is associated with increased mortality risk A prospective observational study in 287 haemodialysis patients has found that patients who died during the five-year observation period differed in several respects from those who survived, including a greater intra-dialytic weight gain. In a Cox proportional hazard survival analysis, adjusting for several covariates, the body weight-adjusted UF rate appeared as an independent predictor of death (p<0.0001), while intra-dialytic weight gain did not. The authors conclude that longer or more frequent sessions should be considered in patients requiring high UF rates. [Movilli E et al, Nephrol Dial Transplant. 2007;22(12):3547-52] Clinical studies look at high-flux dialyzers Two clinical studies performed by a team from Louisville, USA, benchmarked the performance of high-flux dialyzers. Comparing the Gambro Polyflux H series to Fresenius Optiflux and Polyflux S to the F series, the Polyflux filters respectively showed some 140% and 75% greater clearance for beta-2-microglobulin. Other middle molecules were also better cleared by the Polyflux dialyzers, while urea and phosphate removals were similar. The paper emphasises that membranes made of apparently similar polymers may differ substantially in the removal of small protein uremic toxins. [Ouseph R et al; Nephrol Dial Transplant Advance Access Dec 21, 2007] Beta-2-microglobulin serum level is associated with infectious mortality in dialysis patients A recent analysis of data from 1813 chronic HD patients participating in the HEMO study found that for each 10 mg/l greater serum b2m level the risk for infectious death increased by 21%, which was statistically highly significant. The effect was not dependant on how long patients had been on dialysis. This data supports the use of high-flux dialyzers to increase the removal of middle molecules and the use of serum b2m level as marker of uremic toxicity. [Cheung AK et al, Clin J Am Soc Nephrol 2008;3:69-77] Investment in upgraded training facilities now ensures a better experience for delegates Technical training facilities upgraded Renovation work at our Huntingdon head office has created a custom built area for technical training. Perhaps the best feature is the newly-installed central water plant (CWP), but this is just one of the areas in which we have invested. Work on the CWP began in December with the local water company installing the necessary external infrastructure. Ian Proud, Gambro’s National Field Technician for water products, and Chris Matthews, Team Leader for National Specialists, then installed the CWP to provide clean water to four points in the training room. Kirsty James, Junior Product Manager for Technical Services, says: “As well as the new water points, the training room also has a new self draining resin floor, improved lighting and an interactive IT whiteboard. The refurbishment is one of the outcomes of an overall review of our training services. More changes will follow, all of which will make our technical training a more pleasurable experience for participants.” Contact Kirsty James 01480 444055 kirsty.james@gambro.com 6 clinical corner